Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence.

BACKGROUND: The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses. OBJECTIVES: This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL. METHODS: The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days. RESULTS: From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01). CONCLUSIONS: We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.

Cultivating Self-Compassion to Protect Nurses From Burnout and Secondary Traumatic Stress.

Nursing burnout, a result of prolonged occupational stress, has always been a challenge in health care, but recently the COVID-19 pandemic made this issue into a national priority. In fact, burnout among health care workers is one of the four priorities of the U.S. Surgeon General. Health care leaders and organizations are eager to implement strategies to improve nurses' well-being and, thus, enhance their mental health. Much of the literature has focused on the antecedents and consequences of nursing burnout, but there is limited information on strategies that protect perinatal nurses from burnout. Self-compassion is emerging as one strategy that has a positive correlation with nurse well-being and a negative association with burnout, depression, and anxiety. In this article, we identify and translate strategies to promote self-compassion in perinatal nurses.

PRIME-nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability.

The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings.

Implementing an evidence-based guideline to decrease opioids after cardiac surgery.

BACKGROUND: Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem. LOCAL PROBLEM: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented. METHODS: This is a single-center, pre-post quality improvement project in adult patients after elective cardiac surgery through sternotomy. INTERVENTIONS: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge. RESULTS: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% ( p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% ( p < .001) and with 25 or less MME from 30% to 55% ( p < .01). Acetaminophen prescription at discharge increased from 10% to 48% ( p < .001). CONCLUSIONS: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.

Resilience and Ethics in Nursing Education and Practice: Needs and Opportunities.

BACKGROUND: Nursing faculty and clinicians are leaving the profession due to increased workload and burnout. Evidence-based interventions to build skills in resilience and well-being are encouraged; however, strategies to implement them in nursing curricula and nurse residency programs (NRPs) are not well known. PURPOSE: To understand the current state of resilience, well-being, and ethics content in the curriculum in schools of nursing and NRPs in the state of Maryland as part of a statewide initiative for Renewal, Resilience and Retention of Maryland Nurses (R3). METHODS: A descriptive survey was distributed to leaders of all Maryland nursing schools and NRP directors. RESULTS: Respondents (n = 67) reported minimal resilience, well-being, and ethics content. Teaching modalities included lecture, journaling, mindfulness, and the code of ethics. Barriers included lack of faculty knowledge, low priority, time constraints, and limited resources. CONCLUSION: Resilience, well-being, and ethics content is limited in nursing curricula. Developing educator skills and best practices to foster resilience and ethical practice are needed.

The impact of full practice authority on nurse practitioner compensation, collaboration, and billing.

BACKGROUND: Although there is a substantial body of evidence regarding full practice authority's (FPA) effects on health care access and quality, very little research has examined how nurse practitioner (NP) licensure laws affect the status of NPs as clinicians, employees, and leaders in health care organizations. PURPOSE: This study examined whether states' implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs' and whether NPs' gains from FPA increase over time in states where FPA has been in effect longer. METHODOLOGY: Data from a nationwide survey of licensed NPs ( N = 5,770) were used to compare NPs' employment conditions between FPA and non-FPA states. After balancing the FPA and non-FPA groups on demographic characteristics (e.g., urbanicity, education), adjusted mean differences in outcomes between the groups were estimated using weighted multivariable regression. RESULTS: Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings ( p < .05), were more likely to be practice owners or shareholders ( p < .01), and billed a greater percentage of their patient visits under their own National Provider Identifier ( p < .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA <10 years. CONCLUSIONS: States' adoption of FPA for NPs is associated with improved conditions of employment among NPs. IMPLICATIONS: Untethering NPs from physicians establishes a cascade of modest gains in income and practice ownership that may indicate changes over time. Additional research is needed to determine the trajectory of these increases and if they are consistent.

COVID-19: Implications for Nursing and Health Care in the United States.

PURPOSE: COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary. DESIGN AND METHODS: Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus. FINDINGS: Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce. CONCLUSIONS: The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all. CLINICAL RELEVANCE: The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims.

Improving healthcare quality for transgender patients in the perioperative setting: The patient's perspective.

Transgender individuals reported higher rates of discrimination and barriers to care within healthcare settings than their cisgender counterparts. There is a paucity of literature concerning the barriers experienced within perioperative healthcare settings. Participants completed a sociodemographic questionnaire and a 7-item Likert-type scale survey: the Everyday Discrimination Scale Adapted for Medical Settings. Overall, 57% of trans-individuals who underwent gender-affirming surgery reported perceptions of discrimination when interacting with healthcare providers within the perioperative setting according to responses from the Discrimination in Medical Settings Survey. There was an overall difference in the summary scores between participants based on gender transition. These findings highlight an opportunity to address barriers to care related to discrimination and negative patient-provider interactions. These findings have implications for the development and integration of patient-informed, evidence-based, trans-specific, educational and cultural competency trainings to enhance the healthcare professional's knowledge, attitudes, comfort and ability to care for the transgender population.Key phrases: Transgender individuals reported higher rates of discrimination and barriers to care; enhancing the healthcare professional's knowledge, attitudes, comfort and ability to care for the transgender population; opportunities to address barriers to care related to discrimination and negative patient-provider interactions; individuals who transitioned from male-to-female (MTF) had higher scores related to perceptions of discrimination during interactions with healthcare providers.

Nursing Students with Disabilities: A Guide to Providing Accommodations.

The number of nursing students with disabilities entering nursing school continues to rise along with the critical need for nurses. According to federal law, accommodations must be implemented in the classroom and clinical area for nursing students with disabilities. Faculty and administrators must protect the civil rights of those with disabilities by addressing barriers to student success and establishing accommodations. By using adaptive equipment, service animals, and other accommodations, nursing students with disabilities can be successful in providing safe and effective care to patients and add to diversity and inclusion in the nursing profession.

Proposed Mechanism of Adherence in Caregivers Providing Care to Adults Living with a Left Ventricular Assist Device.

Introduction: The left ventricular assist device (VAD) is commonly used as the bridge-to-transplantation therapy for heart failure patients who are on waitlist of heart transplant. The caregivers' adherence to the homecare regimen plays a vital role in patient outcomes. There is little evidence about the factors related to the caregiver adherence. The purpose of this study was to determine the factors influencing adherence in caring for patients living with a left ventricular device. Methods: The data were collected from 4 online caregiver support groups. Multiple linear regression models were used to determine associations between key variables. The structure equation modeling was used to identify the mediators of caregiver adherence. Results: A total of 96 participants' data entered the final analysis. The average age of the participants was 49.8 (SD = 12.88) years, majority were white (84%), female (80%), and married (81%). Caregiver self-efficacy was positively related to their adherence (r = 0.460, P < 0.001). Caregiver knowledge did not mediate the effect of training on self-efficacy. Caregiver self-efficacy did not mediate the effect of knowledge on adherence. There was no interaction between practice hours and knowledge on adherence. Discussion: The findings suggest significant association between caregiver self-efficacy and adherence to left ventricular assist home-care regimens. Additional research is needed to identify factors influencing caregiver adherence, leading to the development of evidence-based practice guidelines and to improve the outcomes in advanced heart failure patients living with left VAD.

Establishing the doctor of nursing practice project ethical review process to improve standardization, efficiency, and timeliness.

BACKGROUND: DNP Scholarly projects require review for scientific merit and human subject protection. Rapid growth of DNP programs and projects has increased Institutional Review Board (IRB) burden and increased the length of project approval time when most DNP scholarly projects are quality improvement (QI) projects and not deemed Human Subjects Research (HSR). PURPOSE: Develop a process and describe the rationale for creating and implementing a Project Ethical Review Committee (PERC) in the School of Nursing and to evaluate the experience of the first cohort of submissions. PROCESS: Committee was formed using expert consensus approach, in collaboration with IRB. Standards of Procedures and training materials created. OUTCOME MEASURE: 100 projects submitted to committee; 95 deemed QI (95%) and 5 projects considered HSR (5%). First 94 projects were reviewed, and approval letters sent within 8 weeks. DISCUSSION: This paper discusses how PERC ensures rigorous and ethical review process for standardization, timeliness, and efficiency.

Cognitive Function and Sleep in Caregivers of Persons Living with Dementia.

Poor sleep is prevalent among caregivers of persons living with dementia and increases their risk for cognitive impairment and decline. In this cross-sectional, correlational study, we compared the cognitive function scores of caregivers with poor sleep with the demographically adjusted normed scores of the National Institutes of Health Toolbox Cognition Battery. Caregivers completed a 14-day sleep diary. On average, caregivers (n = 28) were 65.14 (±10.08) years, female, and White. Their average crystallized cognitive function composite score was significantly higher and their average fluid cognitive function composite score was significantly lower than the normative scores. Caregivers performed significantly worse on the processing speed domain measure. Poor sleep may affect how caregivers, including highly educated caregivers, process and respond to information, thus can influence how they safely perform complex caregiving tasks. Health care providers should consistently assess caregivers' sleep and cognitive abilities to promptly identify changes and provide timely interventions.

Increasing the Number of Faculty With CNE® Certification: A Statewide Initiative.

ABSTRACT: This article describes outcomes of a statewide initiative to increase the number of faculty with the National League for Nursing's Certified Nurse Educator (CNE®) credential. After offering CNE preparation workshops and creating a certification award, data were collected on perceived workshop effectiveness, readiness to test, certification pass rates, and characteristics of award recipients. The number of certified faculty increased by 92.3 percent, representing 24 of 28 nursing programs. Maryland faculty were awarded $625,000 through the Academic Nurse Educator Certification award.

A competency roadmap for advanced practice nursing education using PRIME-NP.

BACKGROUND: Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive. PURPOSE: This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses. METHODS: To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use. FINDINGS: Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students. CONCLUSION: The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.

Advance Directives for Adolescents and Young Adults Living With Neuromuscular Disease: An Integrative Review of the Literature.

The use of advance directives is an important component in helping individuals living with chronic and/or life-threatening illnesses establish goals of care and make decisions regarding care at the end of life. Advance care planning may help achieve enhanced health outcomes, yet it is not routinely offered to adolescents/young adults living with neuromuscular disease. An integrative review of the literature was conducted to examine the evidence related to the use of advance directives with adolescents/young adults living with neuromuscular disease and to identify reasons why they are not being used and how this can be improved. Three-hundred-seven studies were retrieved from PubMed, CINAHL, and EMBASE. Five studies met the final inclusion search criteria and were included in the analysis. Four themes emerged from the literature: conversations about advance directives with adolescents/young adults with neuromuscular disease are not being conducted, only a small number of patients have documented advance directives, patients want to have conversations about goals of care and want to have them sooner, and there is a lack of evidence in this area. These findings may influence neuromuscular clinicians' practice surrounding the use of advance directives and increase their knowledge regarding the need for discussions regarding goals of care.

Faculty peer review of teaching taskforce: A quantitative descriptive research study for the peer review process.

BACKGROUND: Peer review of teaching is important for both the faculty and student experience. Enhanced awareness of student learning experiences and a deeper reflection on teaching makes this process attractive to faculty leaders, staff and students. Evidence suggests that teachers who are reviewed gain confidence, anticipate improvement in teaching and are inclined to discuss their teaching with colleagues in the future. OBJECTIVE: To describe the development of a peer review of teaching process by the Faculty Peer Review of Teaching Taskforce at a school of nursing. METHODS: A five-step Design for Six Sigma methodology was used and includes: Define, Measure, Analyze, Design, Verify (DMADV). In keeping with this methodology we: (1) established a Faculty Peer Review of Teaching Taskforce; (2) conducted a literature review on best practices; (3) reviewed peer institution practices; and (4) surveyed faculty to obtain their perspectives on the qualities of good teaching and the peer review of teaching process. Twenty-seven of the 68 full-time faculty members returned Qualtrics surveys (return rate = 39.7%). RESULTS: Review of the literature yielded four major themes, including post-observation discussion and systematic assignment of peer review pairs. Variation in practices across institutions was identified, from formal structured processes, to peer review conducted only in special circumstances. Survey findings revealed that faculty members overwhelmingly endorse the qualities of good teaching, agree that the peer review process should be required, and that peer reviewers should have several years of teaching experience. CONCLUSIONS: Our faculty were supportive of a peer review teaching process. As teaching demands continue to increase given the evolving complexities of nursing care, teaching platforms (i.e. online, hybrid), and diverse student body, we hope the process we develop may serve as a model for other higher education schools to enhance and maintain excellence in teaching for both the faculty and student experience.

Innovative Simulation Roadmap for Faculty to Prepare Advanced Practice Registered Nurses for Entry Into Practice.

ABSTRACT: Advanced practice registered nurse (APRN) programs are challenged to provide clinical learning experiences that prepare graduates with the full continuum of expected competencies. Preparing the APRN in academia, in terms of didactic and clinical application for novice entry, is often a vexing balance between board certification preparedness and the actualities of clinical practice. This article presents an innovative strategy to examine the perplexing reflective question often asked by educators: Does the current approach for simulation development prepare our APRN students sufficiently for entry into practice, and is it current to what is occurring in practice?

Improving hypertension knowledge, medication adherence, and blood pressure control: A feasibility study.

AIMS AND OBJECTIVES: To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension. BACKGROUND: Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension. DESIGN: Pre-test and post-test feasibility study. METHODS: A convenience sample of forty-four participants who identified as Haitian immigrants was enrolled in this evidence-based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill-Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes. RESULTS: Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six-week follow-up period. CONCLUSION: The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in-depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities. RELEVANCE TO CLINICAL PRACTICE: Advanced practice nurses are uniquely qualified to implement evidence-based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence-based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.